Abstract 9219: Community-Level Cardiovascular Risk Factors Impact Geographic Variation in Cardiovascular Disease Hospitalizations for Women

Abstract

Background: Prior work has shown significant geographic variation in cardiovascular (CV) risk factors including metabolic syndrome, obesity, and hypercholesterolemia. However, little is known about how variations in CV risk impact CVD-related hospitalizations. Methods: Community-level CV risk factors (hypertension, dyslipidemia, hyperglycemia, and elevated waist circumference) were assessed from community-wide health screenings sponsored by Sister to Sister (STS) from Jan 2008-Jan 2009 in 17 major US cities. Using data from the Healthcare Cost and Utilization Project (HCUP), CVD hospitalizations were identified based on ICD9 codes for myocardial infarction (AMI), congestive heart failure (CHF), and other CVD discharges. We linked STS data with HCUP hospitalizations based on common cities and restricted the analysis to women discharged from hospitals inside the 17 STS cities. Using hierarchical models with city as a random intercept, we assessed the impact of city-specific CV risk factors on between-city variance of AMI, CHF, and other CVD hospitalization rates. Analyses were also adjusted for patient age and clinical comorbidities. Results: Our analysis yielded a total of 742,445 all-cause discharges across 70 hospitals inside of 13 linked cities. The mean age of women was 51.8 (SD 21.7) with a range of 15 to 101. The overall (city-specific range) proportion of AMI, CHF, and other CVD hospitalizations were 1.03% (0.75 to 1.49%), 2.32% (1.64 to 3.94%), and 2.85% (1.66% to 4.72%), respectively. After adjusting for city-specific CV risk factors, between-city variation was no longer statistically significant for all targeted conditions (Table). Conclusion: We demonstrated that geographic variations in AMI, CHF, and other CVD hospitalizations can be partially explained by community-level CV risk factors. This finding suggests that interventions to reduce CVD should be tailored to the unique risk profile and needs of high-risk communities.